LAUSR

Congenital heart diseases (CHDs) are the most prevalent congenital anomalies; the presence of these diseases has a significant impact on the prognosis of preterm babies. Prematurity and CHDs might restrict the process of treatment each other and result in exacerbation of clinical conditions of infants. Although maturity is an important factor for better results in any field of childhood surgery, awaiting bodyweight gain could result in worse outcomes of disease, missing the best time for surgery. Especially for preterm babies born before the 28th week of gestation, the complications of bronchopulmonary dysplasia (BPD) and CHDs with an increase in pulmonary artery flow could induce pulmonary hypertension, the most fatal complication of BPD. The smaller the birthweight, the greater the necessity of prospective plans for surgical intervention. Despite the efforts to improve the potential survival rates of preterm babies who have CHDs, few reports have focused on assessing the developmental prognosis of survivors in Japan. Having reported that children with CHDs have higher rates of retardation of neurocognitive development, the American Heart Association announced a scientific statement encouraging screening and support for children with CHDs to detect issues with neurocognitive development. In this issue of our journal, Tomotaki et al. report the prognosis for very low birthweight (VLBW) preterm babies with CHDs at 3 years of age. The survival rate of VLBWs without inborn complications, such as chromosomal aberrations, did not differ significantly from the survival rate in those whose birthweight was more than 1,500 g. Very low birthweights with single-ventricular circulation had a significantly poorer prognosis regarding mental development than those with biventricular circulation. Similar results were reported by Yoshida et al. as well in a previous issue of our journal. Both reports were presented from a socalled high-volume center where both VLBW cases and CHD cases are abundant. As the outcomes of cases in these high-volume centers are usually better than the average outcomes of all-Japan results, a multicenter study is required. One of the difficulties in planning a multicenter trial is the unification of assessment batteries for the development of subjects. In this study, Tomotaki used the Kyoto Scale of Psychological Development (K-shiki), whereas Yoshida used the Bayley Scale of Infant and Toddler Development-III (Bayley-III). The K-shiki is widely used in Japan, not only in medical institutions but also in community health-care centers, and the questions and tasks are suited to Japanese culture and daily life. The K-shiki can be applied from infants to adults. Unfortunately, it is used only in Japan. This makes it difficult to compare the results of perinatal and neonatal medicine in Japan with those of other countries, especially in terms of developmental prognosis. The Bayley-III is used globally as a standard assessment tool for the development of infants and toddlers. As it was developed in the USA, some of the questions and tasks in Bayley-III are not quite familiar to the Japanese. Bayley-III is for toddlers younger than 42 months; therefore, we cannot assess patients with one battery throughout their toddler and school-age life, which might make it difficult for patients’ parents to “feel” the progress in their child’s development. Although the number of institutions in Japan where the Bayley-III is adopted is increasing, it is still limited to specific institutions, such as university hospitals and children’s hospitals. The high lifesaving rates of VLBWs and CHDs in Japan are internationally recognized. To report the results of thorough and meticulous care for supporting the development of children with complications, it is necessary to sustain efforts to establish relevant strategies.